NR-327 Maternal-Child Nursing NCLEX MCQs (QUESTIONS AND ANSWERS)
Core High-Yield Exam Questions & Detailed Rationales
1. Advanced Maternal-Fetal (Preeclampsia & Magnesium Toxicity)
Question: A 26-year-old G1P0 at 34 weeks gestation is admitted with severe preeclampsia.
The nurse has initiated a maintenance infusion of Magnesium Sulfate at 2 g/hr. During an
hourly assessment, the nurse notes: Blood Pressure 142/88 mmHg, Respiratory Rate 10
breaths/min, Deep Tendon Reflexes (DTRs) are absent (0), and urinary output is 15 mL
over the last hour. What is the priority nursing action?
A. Stop the Magnesium Sulfate infusion immediately and prepare to administer
Calcium Gluconate.
B. Increase the primary IV fluid rate to flush the kidneys and reverse the oliguria.
C. Continue to monitor the client; the blood pressure is approaching a safe target
zone.
D. Notify the health care provider immediately to request a serum magnesium level.
Answer: A Rationale: The client is exhibiting classic, definitive signs of Magnesium
Sulfate toxicity: respiratory depression (RR less than 12 breaths/min), loss of deep tendon
reflexes (DTRs), and severe oliguria (urinary output less than 30 mL/hr), which allows the
magnesium to accumulate rapidly since it is excreted renally. The immediate priority is to
stop the toxic infusion to prevent cardiac or respiratory arrest, then prepare the antidote,
Calcium Gluconate (typically 1 g IV pushed slowly over 3 to 5 minutes). Increasing primary
fluids (B) will not reverse toxicity and risks triggering pulmonary edema. Waiting for lab
results (D) or continuing to monitor (C) delays life-saving intervention.
2. Intrapartum Critical Care (Late Decelerations & Intrauterine Resuscitation)
Question: While monitoring a laboring client at 39 weeks gestation who is receiving
Oxytocin, the nurse notes a pattern of uniform fetal heart rate (FHR) decelerations that
begin after the peak of the contraction and return to baseline well after the contraction has
ended. The baseline FHR is 145 bpm with moderate variability. Which sequence of
interventions must the nurse execute?
A. Turn the client onto their back, apply oxygen via nasal cannula at 2 L/min, and
increase the Oxytocin rate.
, B. Discontinue Oxytocin, reposition the client to a lateral position, administer a
bolus of lactated Ringer's, and apply oxygen at 8–10 L/min via non-rebreather
mask.
C. Perform a sterile vaginal exam to check for cord prolapse, then place the client in
Trendelenburg position.
D. Prepare the client for an immediate vacuum-assisted vaginal delivery and stop
the primary IV line.
Answer: B Rationale: The description depicts late decelerations, which indicate
uteroplacental insufficiency (hypoxia). The correct protocol is immediate intrauterine
resuscitation.
1. Stop Oxytocin immediately to eliminate uterine hyperstimulation and allow the
placenta to perfuse.
2. Reposition the client laterally (left or right) to shift uterine weight off the vena
cava.
3. Administer an IV fluid bolus to maximize maternal blood volume and placental
blood flow.
4. Apply high-flow oxygen via non-rebreather (8–10 L/min) to optimize maternal-
fetal oxygen transfer. Nasal cannulas (A) are inefficient for fetal distress, and supine
positioning worsens vena cava compression.
3. Postpartum Hemorrhage (Atony vs. Laceration Parsing)
Question: A nurse is assessing a client 45 minutes after a precipitous vaginal delivery of a 9
lb 4 oz infant. The nurse notes a steady, trickle of bright red vaginal bleeding. Upon
palpation, the uterine fundus is found to be firm, midline, and located 1 cm below the
umbilicus. Which etiology should the nurse suspect as the primary cause of this bleeding?
A. Uterine Atony
B. Retained Placental Fragments
C. Cervical or Vaginal Laceration
D. Disseminated Intravascular Coagulation (DIC)
Answer: C Rationale: The defining clinical clue here is a firm, well-contracted uterine
fundus paired with continuous, steady bleeding. If the fundus is firm, the bleeding is not
coming from uterine atony (A). A steady stream or trickle of bright red blood despite a firm
uterus points directly toward a laceration of the cervix, vagina, or perineum, common in
precipitous (rapid) deliveries or with large-for-gestational-age infants. Retained fragments
, (B) typically present with a boggy, subinvolutionized uterus. DIC (D) presents with
generalized bleeding from IV sites, gums, and ecchymosis, not an isolated vaginal trickle.
4. Neonatal Transition (Respiratory Distress Syndrome vs. TTN)
Question: A preterm infant delivered at 31 weeks gestation is admitted to the NICU. At 30
minutes of life, the infant exhibits tachypnea (RR 78/min), generalized cyanosis on room
air, intercostal retractions, expiratory grunting, and nasal flaring. Which pathophysiological
mechanism explains this presentation?
A. Delayed clearance of fetal lung fluid from the alveolar spaces.
B. Alveolar collapse caused by a deficiency of surfactant production.
C. Unclosed ductus arteriosus causing a massive left-to-right shunt.
D. Meconium aspiration triggering chemical pneumonitis.
Answer: B Rationale: This infant is presenting with Respiratory Distress Syndrome
(RDS), typical in premature neonates born before 34 weeks due to underdeveloped type II
alveolar cells failing to produce sufficient surfactant. Without surfactant, alveolar surface
tension increases, leading to widespread atelectasis (alveolar collapse), retractions, and
expiratory grunting (the baby's attempt to maintain positive end-expiratory pressure).
Delayed fluid clearance (A) describes Transient Tachypnea of the Newborn (TTN), which is
more common in term/near-term infants delivered via Cesarean section without labor.
5. Pediatric Medical-Surgical (Congenital Heart Defects - Tetralogy of Fallot)
Question: A 7-month-old infant with Tetralogy of Fallot begins to cry violently during an IV
insertion attempt, becomes intensely cyanotic, and displays rapid, gasping respirations.
Which action should the nurse take first?
A. Administer a standard dose of Morphine Sulfate intramuscularly.
B. Place the infant immediately into a knee-chest position.
C. Apply high-flow oxygen via a blow-by tubing mechanism.
D. Obtain a stat arterial blood gas (ABG) to determine the severity of hypoxia.
Answer: B Rationale: The infant is experiencing a hypercyanotic spell, commonly known
as a "Tet spell." This occurs when a sudden drop in systemic vascular resistance (or
increase in pulmonary vascular resistance, like during crying) forces deoxygenated blood
through the ventricular septal defect directly into the aorta. Placing the infant in a knee-
chest position (or flexing the legs at the hips) immediately increases systemic vascular
resistance, which forces more blood out of the right ventricle, through the stenotic
pulmonary valve, and into the lungs to be oxygenated. While Morphine (A) and Oxygen (C)
Core High-Yield Exam Questions & Detailed Rationales
1. Advanced Maternal-Fetal (Preeclampsia & Magnesium Toxicity)
Question: A 26-year-old G1P0 at 34 weeks gestation is admitted with severe preeclampsia.
The nurse has initiated a maintenance infusion of Magnesium Sulfate at 2 g/hr. During an
hourly assessment, the nurse notes: Blood Pressure 142/88 mmHg, Respiratory Rate 10
breaths/min, Deep Tendon Reflexes (DTRs) are absent (0), and urinary output is 15 mL
over the last hour. What is the priority nursing action?
A. Stop the Magnesium Sulfate infusion immediately and prepare to administer
Calcium Gluconate.
B. Increase the primary IV fluid rate to flush the kidneys and reverse the oliguria.
C. Continue to monitor the client; the blood pressure is approaching a safe target
zone.
D. Notify the health care provider immediately to request a serum magnesium level.
Answer: A Rationale: The client is exhibiting classic, definitive signs of Magnesium
Sulfate toxicity: respiratory depression (RR less than 12 breaths/min), loss of deep tendon
reflexes (DTRs), and severe oliguria (urinary output less than 30 mL/hr), which allows the
magnesium to accumulate rapidly since it is excreted renally. The immediate priority is to
stop the toxic infusion to prevent cardiac or respiratory arrest, then prepare the antidote,
Calcium Gluconate (typically 1 g IV pushed slowly over 3 to 5 minutes). Increasing primary
fluids (B) will not reverse toxicity and risks triggering pulmonary edema. Waiting for lab
results (D) or continuing to monitor (C) delays life-saving intervention.
2. Intrapartum Critical Care (Late Decelerations & Intrauterine Resuscitation)
Question: While monitoring a laboring client at 39 weeks gestation who is receiving
Oxytocin, the nurse notes a pattern of uniform fetal heart rate (FHR) decelerations that
begin after the peak of the contraction and return to baseline well after the contraction has
ended. The baseline FHR is 145 bpm with moderate variability. Which sequence of
interventions must the nurse execute?
A. Turn the client onto their back, apply oxygen via nasal cannula at 2 L/min, and
increase the Oxytocin rate.
, B. Discontinue Oxytocin, reposition the client to a lateral position, administer a
bolus of lactated Ringer's, and apply oxygen at 8–10 L/min via non-rebreather
mask.
C. Perform a sterile vaginal exam to check for cord prolapse, then place the client in
Trendelenburg position.
D. Prepare the client for an immediate vacuum-assisted vaginal delivery and stop
the primary IV line.
Answer: B Rationale: The description depicts late decelerations, which indicate
uteroplacental insufficiency (hypoxia). The correct protocol is immediate intrauterine
resuscitation.
1. Stop Oxytocin immediately to eliminate uterine hyperstimulation and allow the
placenta to perfuse.
2. Reposition the client laterally (left or right) to shift uterine weight off the vena
cava.
3. Administer an IV fluid bolus to maximize maternal blood volume and placental
blood flow.
4. Apply high-flow oxygen via non-rebreather (8–10 L/min) to optimize maternal-
fetal oxygen transfer. Nasal cannulas (A) are inefficient for fetal distress, and supine
positioning worsens vena cava compression.
3. Postpartum Hemorrhage (Atony vs. Laceration Parsing)
Question: A nurse is assessing a client 45 minutes after a precipitous vaginal delivery of a 9
lb 4 oz infant. The nurse notes a steady, trickle of bright red vaginal bleeding. Upon
palpation, the uterine fundus is found to be firm, midline, and located 1 cm below the
umbilicus. Which etiology should the nurse suspect as the primary cause of this bleeding?
A. Uterine Atony
B. Retained Placental Fragments
C. Cervical or Vaginal Laceration
D. Disseminated Intravascular Coagulation (DIC)
Answer: C Rationale: The defining clinical clue here is a firm, well-contracted uterine
fundus paired with continuous, steady bleeding. If the fundus is firm, the bleeding is not
coming from uterine atony (A). A steady stream or trickle of bright red blood despite a firm
uterus points directly toward a laceration of the cervix, vagina, or perineum, common in
precipitous (rapid) deliveries or with large-for-gestational-age infants. Retained fragments
, (B) typically present with a boggy, subinvolutionized uterus. DIC (D) presents with
generalized bleeding from IV sites, gums, and ecchymosis, not an isolated vaginal trickle.
4. Neonatal Transition (Respiratory Distress Syndrome vs. TTN)
Question: A preterm infant delivered at 31 weeks gestation is admitted to the NICU. At 30
minutes of life, the infant exhibits tachypnea (RR 78/min), generalized cyanosis on room
air, intercostal retractions, expiratory grunting, and nasal flaring. Which pathophysiological
mechanism explains this presentation?
A. Delayed clearance of fetal lung fluid from the alveolar spaces.
B. Alveolar collapse caused by a deficiency of surfactant production.
C. Unclosed ductus arteriosus causing a massive left-to-right shunt.
D. Meconium aspiration triggering chemical pneumonitis.
Answer: B Rationale: This infant is presenting with Respiratory Distress Syndrome
(RDS), typical in premature neonates born before 34 weeks due to underdeveloped type II
alveolar cells failing to produce sufficient surfactant. Without surfactant, alveolar surface
tension increases, leading to widespread atelectasis (alveolar collapse), retractions, and
expiratory grunting (the baby's attempt to maintain positive end-expiratory pressure).
Delayed fluid clearance (A) describes Transient Tachypnea of the Newborn (TTN), which is
more common in term/near-term infants delivered via Cesarean section without labor.
5. Pediatric Medical-Surgical (Congenital Heart Defects - Tetralogy of Fallot)
Question: A 7-month-old infant with Tetralogy of Fallot begins to cry violently during an IV
insertion attempt, becomes intensely cyanotic, and displays rapid, gasping respirations.
Which action should the nurse take first?
A. Administer a standard dose of Morphine Sulfate intramuscularly.
B. Place the infant immediately into a knee-chest position.
C. Apply high-flow oxygen via a blow-by tubing mechanism.
D. Obtain a stat arterial blood gas (ABG) to determine the severity of hypoxia.
Answer: B Rationale: The infant is experiencing a hypercyanotic spell, commonly known
as a "Tet spell." This occurs when a sudden drop in systemic vascular resistance (or
increase in pulmonary vascular resistance, like during crying) forces deoxygenated blood
through the ventricular septal defect directly into the aorta. Placing the infant in a knee-
chest position (or flexing the legs at the hips) immediately increases systemic vascular
resistance, which forces more blood out of the right ventricle, through the stenotic
pulmonary valve, and into the lungs to be oxygenated. While Morphine (A) and Oxygen (C)
